Acta Oto-Laryngologica最新文献

Background: The Supraclavicular artery islanded flap (SCAIF) is commonly used for the reconstruction of oral cavity defects.

Aim: This study evaluated the incidence of donor site phantom sensation following SCAIF reconstruction.

Methods: This was a prospective cohort study conducted on all consecutive cases of SCAIF reconstruction undertaken for oral cavity reconstruction over 3 years. The primary outcome was to document the incidence of phantom sensation at the donor site arising from sensory stimulation of the skin paddle in the oral cavity. The study was undertaken using questions to assess the type and duration of phantom symptoms.

Results: Of the 105 SCAIF reconstructions undertaken during this period, 30 (28.57%) of the patients were found to have phantom sensations. The spectrum of phantom sensations referred over the deltoid region were tactile (23), temperature (23) and pain (10). The mean duration of phantom sensation was 16.4 months (range: 6 months to 36 months). Intraoperative sectioning of supraclavicular nerves during flap harvest was shown to minimise the incidence of the development of phantom sensation (Odds ratio: 4.42, 95% CI: 0.95-20.40).

Conclusion: This study documented donor site phantom sensation in 28.57% of the patients undergoing SCAIF reconstruction. This carries immense implications in terms of preoperative patient counselling.

Background: Trismus, difficulty opening the jaw, and dysphagia, difficulty swallowing, are complications in head and neck cancer (HNC). Metabolic imbalances, including alterations in amino acids, lipids, and inflammatory markers, potentially influence these conditions.

Aim/objective: The aim of this study was to investigate associations of metabolic and inflammatory metabolites in HNC patients, focusing on trismus and dysphagia.

Material and methods: Nuclear Magnetic Resonance (NMR) spectroscopy, and Bruker IVDr Lipoprotein Subclass analysis was used to analyse metabolites in plasma from 302 patients before, during and after treatment for HNC.

Results: Sixteen lipoprotein subclasses (LDL 1-6, HDL 1-4 VLDL 1-6) as well as creatinine, creatine, glutamine, alanine, glycine, GlycA, GlycB, and a combined lipoprotein-derived NMR signal named Supramolecular Phospholipid Composite (SPC), were analysed. An increase in several lipoprotein sub fractions and elevated inflammatory biomarkers (GlycA and GlycB) were associated with Maximal Interincisal Opening (MIO) before treatment. The M.D. Anderson Dysphagia Inventory (MDADI) before treatment was associated with elevated GlycA and GlycB. The results also showed significant correlations between metabolites and BMI, sex, age, radiation therapy as well as tumour stage and location.

Conclusion and significance: Metabolic and inflammatory markers highlight the metabolic heterogeneity in HNC and provide potential targets for future therapeutic strategies.

Background: The studies on malnutrition/obesity and hearing argued that there may be a relationship between malnutrition/obesity and hearing loss, although many used behavioral measurements.

Aims/objectives: To investigate Auditory Brainstem Responses (ABR) in women by considering Body Mass Index (BMI).

Material and methods: A total of 60 females (n = 120 ears) between the ages of 18-40 years participated. All subjects had normal hearing, and they were grouped under three BMI categories (weak, ideal weight and overweight). ABR recorded with Click and CE-Chirp stimuli at 80-60 dB nHL intensity levels. Absolute latencies and inter- peak latencies of waves I, III and V were evaluated. Right-left ears results and the stimulus type (Click or CE-Chirp) were considered.

Results: Mainly, wave V absolute latency and I-V inter-peak latency were longest in subjects who were overweight. No interpretable differences were noted between the ears (p > 0.05). Regarding the stimulus type (Click or CE-Chirp), significant differences were observed in all BMI groups (p < 0.05).

Conclusions and significance: The ABR, which are affected by many other factors, are also directly related to BMI. The importance of taking BMI into consideration when creating normative data in ABR measurements and/or using ABR in clinics is emphasized. The stimulus type caused significant differences.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) impacts the health-related quality of life (HrQoL) and sense of smell. The association between recurrent NPs after surgery and patient-reported outcomes has not been extensively studied.

Objective: To investigate whether patients with recurrent NPs can be distinguished from non-recurrent cases based on pre- and postsurgical evaluations of HrQoL, sense of smell, blood eosinophils and fractional exhaled nitric oxide (FeNO).

Methods: Thirty-five patients with CRSwNP were recruited pre-surgery and followed up to 12 months post-surgery. HrQoL was assessed with RAND-36 and SNOT-22, olfactory dysfunction with smell test and self-reported.

Results: SNOT-22 scores improved 6 months post-surgery but deteriorated 12 months post-surgery with no significant difference related to recurrent NPs. Patients with recurrent NPs had lower smell test scores and more frequent self-reported anosmia or hyposmia as well as higher blood eosinophil counts at pre-surgery. FeNO did not change post-surgery and was not related to NP recurrence.

Conclusion: A low smell test result before surgery may serve as an early indicator of recalcitrant NPs, whereas preoperative scores from HrQoL questionnaires may not be a good predictor. We confirm a significant role for blood eosinophils in refractory CRSwNP, while FeNO may not predict rapid NP recurrence.

Background: Understanding the anatomy and orientation of the semicircular canals is essential for effective diagnosis and treatment.

Aims: We aimed to examine the angular relationship between the auricular helix and the PSC to explore a potential visual reference for benign paroxysmal positional vertigo (BPPV) management.

Material and methods: Adult patients scheduled for temporal bone or paranasal sinüs computed tomography (CT) scans participated in this study. Using the Protractor application, we measured the cephaloauricular angles (CAA) and sagittal auricular angles (SAA). The PSC angles (PSCA) measurments were obtained from the CT images. Statistical analyses, including descriptive statistics and correlation tests, assessed the relationships between these measurements.

Results: Fifty ears from 25 participants (14 males, 11 females) were analyzed. The mean CAA was 33.6° (±11.0), the SAA was 27.6° (±11.1), and the PSCA was 43.1° (±6.5). The average differences between the PSCA and the CAA and SAA were 9.6° and 15.6°, respectively.

Conclusions: This study indicates an anatomical alignment between the auricular helix and the PSC. Utilizing the external auricle as a reference during repositioning maneuvers could enhance both educational and clinical practices related to BPPV.

Background: Fungal ball has been known as a noninvasive subtype of chronic rhinosinusitis (CRS). Recently, other endotypes of sinonasal bioballs, which we reported as bacterial balls and mixed balls.

Objectives: This study aimed to investigate the pseudoball as a distinct endotype of sinonassal bioballs.

Methods: This study included 41 CRS patients with suspected fungal balls who underwent functional endoscopic sinus surgery (FESS) from January 2020 to November 2022. All fungus-like biomaterials were stained with Hematoxylin-Eosin, Gomori-Methenamine-Silver (GMS), and Gram stains. Diagnosis of pseudoballs was made when both GMS and Gram staining were negative. Clinical and computed tomography (CT) findings were compared between fungal balls and pseudoballs.

Results: Four endotypes of sinonasal bioballs were identified: fungal balls (56.1%), mixed balls (26.8%), pseudoballs (12.2%), and bacterial balls (4.9%). During FESS, the pseudoballs had heterogeneous gross features with a gel-like or semi-solid consistency and yellow-to-gray colors. Histopathology of the pseudoballs showed a matrix with thick acellular mucous material without any fungi or bacteria. When compared with fungal balls, all pseudoballs cases were immunocompetent (100%) and prone to involvement of the posterior ethmoid sinus (60%, p = 0.01) in CT scans.

Conclusions: The pseudoballs were dual-negative in GMS and Gram staining and showed distinct clinical and radiological characteristics as a different endotype.

Backgrounds: Hearing loss (HL) is associated with various functional deficits.

Aims/objectives: This study aimed to evaluate the quality of life (QOL) of patients with HL according to their gender.

Materials and methods: Participants aged 40 or older from the 8th Korea National Health and Nutrition Examination Survey (2019-2021) with data on otologic evaluations and the Health-Related Quality of Life Instrument with 8 Items (HINT-8) were included. They were classified into the bilateral hearing, unilateral hearing, or disabling HL groups based on moderate HL (> 40 dB) in each ear.

Results: Among males, the disabling HL group scored significantly worse in climbing stairs, vitality, working, and depression compared to both the bilateral and unilateral hearing groups (p < 0.05 for all), and reported significantly lower happiness than the bilateral hearing group (p = 0.041). Furthermore, hearing aid users had significantly higher vitality than non-users (p = 0.009). In females, only vitality was significantly worse in the disabling HL group (p = 0.019).

Conclusions and significance: Republic of Korea Male patients with disabling HL experienced a greater decline in QOL and hearing aids might be associated with preserving vitality in males. Further research is required to elucidate greater vulnerability to HL in males.

Introduction: Frontal sinus surgery is among the most technically demanding areas in rhinology due to the complex anatomy of the frontal recess and proximity to critical structures such as the orbit and anterior cranial fossa. Although endoscopic sinus surgery (ESS) is the standard for most sinonasal pathologies, the frontal osteoplastic flap (OPF) remains important in select clinical scenarios.

Objectives: To evaluate the role of OPF in current rhinologic practice by presenting a retrospective case series and reviewing contemporary literature.

Methods: A retrospective analysis was conducted on 11 patients who underwent OPF between 2007 and 2019 at a Portuguese center. Surgical data, indications, approaches, and outcomes were reviewed. A literature review was also performed to contextualize findings.

Results: The most common indications were frontal sinus osteomas, mucoceles with orbital involvement, and refractory chronic frontal sinusitis. Supraciliary and bicoronal incisions were used, and in some cases, combined with ESS. No major complications occurred, and outcomes were highly satisfactory both functionally and esthetically.

Conclusion: Despite advancements in endoscopic techniques, OPF remains a valuable option for anatomically challenging, recurrent, or bone-involving frontal sinus disease. This case series and literature review support its continued role in the comprehensive surgical armamentarium in rhinology.

Background: Nasal septal perforations (NSPs) are a challenging clinical problem due to impaired healing under constant airflow, dryness, and microbial exposure. Adjuncts that enhance mucosal regeneration and extracellular matrix activity are needed.

Objectives: This study evaluated whether topical caffeic acid (CA) delivered in a thermoresponsive Pluronic F127 gel improves histopathological and macroscopic healing in a rat NSP model.

Material and methods: Nineteen male Sprague Dawley rats were randomly assigned to control (n = 8) or CA (n = 11) groups. A standardized full-thickness septal perforation (∼2 mm) was surgically created. Controls received intranasal saline, while the CA group received 0.2 mL CA-loaded Pluronic F127 gel once daily for 14 days. Histopathological parameters (epithelial regeneration, degeneration, fibroblast density, collagen density, angiogenesis, inflammation) were scored on a 0-3 scale. Macroscopic closure was also evaluated. Fisher's exact test was applied (p < 0.05).

Results: CA significantly increased epithelial regeneration (p = 0.005), fibroblast density (p = 0.014), and collagen density (p = 0.018), while reducing epithelial degeneration (p < 0.001). Angiogenesis and inflammation showed favorable trends. Macroscopic closure improved but was not statistically significant (p = 0.101).

Conclusions and significance: Topical CA in a thermoresponsive gel enhanced mucosal repair and extracellular matrix activity in a rat NSP model, supporting its potential as a therapeutic adjunct in septal perforation management.

Background: Although relatively rare, major salivary gland tumors pose notable diagnostic and therapeutic challenges. Accurate preoperative differentiation between benign and malignant lesions is crucial for preoperative surgical planning and better outcomes. Computed tomography (CT-scan) is widely used due to its accessibility and detailed anatomical imaging.

Objective: To evaluate the diagnostic accuracy of preoperative CT-scan in distinguishing malignant from benign major salivary gland tumors, using histopathology diagnosis as the reference standard.

Methods: This retrospective study included 90 patients who underwent surgery for major salivary gland tumors between 2005 and 2019. Preoperative CT-scans were reviewed for radiologic signs of malignancy and compared with histopathological results. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC curve (AUC) were calculated.

Results: Of the 90 tumors, 20 (22.2%) were malignant and 70 (77.8%) benign. CT-scan identified 12 true positives and 61 true negatives, with 10 false positives and 7 false negatives. Sensitivity was 63.2%, specificity 85.9%, PPV 54.5%, NPV 89.7%, and AUC 0.75.

Conclusion: Preoperative CT-scan demonstrates high specificity and NPV for benign tumors but limited sensitivity for malignancies. Histological confirmation remains essential in cases with indeterminate or challenging preoperative imaging features, supporting the use of multimodal diagnostic approaches.